Case Report: An appendicular adenocarcinoma presenting in a strangulated incisional hernia with metastatic sac

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Introduction Appendicular tumors are often found incidentally in appendicular specimens. They are rarely diagnosed preoperatively due to the absence of clinical prodromes or open abdomen. We report a case of appendicular adenocarcinoma triggered by hernia strangulation, with tumoral deposits inside the hernia sac. Case-report An 81-year-old woman presented with a rapidly increasing abdominal pain since 6 days. Upon examination, the umbilicus bulged with overlying sphacelous skin. The patient exhibited inflammatory syndrome. Abdominal CT tomography revealed a strangulated, herniated right colon with an intrasaccular abscess. She was operated on. She underwent appendicectomy and herniorrhaphy. Histological analysis revealed well-differentiated adenocarcinoma. The hernial sac harbors similar cancerous cells. Discussion Tumors revealed during hernia with metastases inside the sac are scarce. In fact, during 39 years of inguinal hernia repair, 0.07% of the patients had a metastatic tumor during herniorrhaphy. This rate reaches 2.2% if we consider all abdominal hernias. This statement suggests the promotion of routine examination of the hernia sac during surgery for a tumor with a co-existent hernia or any elective hernia repair. Routine examination is not justified because of high costs, with fees reaching €21,087.50, to detect one case of a malignant tumor in the hernia sac. Conclusion Surgeons should be aware of the possibility of encountering malignant diseases at hernia sites. It is essential to avoid a hasty and poorly performed examination of the hernia sac to detect suggestive signs of malignancy and then take appropriate action.

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